The intent of the entering class of 1961 indicated that 95 percent preferred to go into practice and 5 percent into research and teaching. If one views this from a somewhat different fashion, not from the intent of students or the number of physicians, but from the total number of professional workers in medical research, our best estimate is that of the 39,700 professional individuals, 11,400 are M.D.'s, D.D.S.'s, D.V.M.'s; 18,000 are Ph. D.'s; and 10,000 have lesser degrees.

Now, the interesting thing, and I want to talk about trends now and I would like to give you a breakdown of the new investigations receiving support for the first time from NIH. Going from 1950 to 1960, in 1950 the M.D.'s constituted 52 percent. These are new ones entering research for the first time.

In 1954, they were 36 percent.
In 1958, they were 37 percent.
In 1960, they were 35 percent.

So that of the people we are supporting, if anything, there is a progressive emphasis on the Ph. D. And a less emphasis on the M.D.'s.

I would like to look at this from another point of view that is equally important. These people are not exclusively in research. These people are in research and education, and, please believe me, gentlemen, were it not for research you would not have adequate faculties in our medical schools today.

I would like to take the figure. We say there are 4,650 physicians acting as principal investigators in research today. That sounds like a large figure. We have about 90 medical schools. This means on the average that there could be as many as 50 M.D.'s associated with each medical school for investigation and research. This will break down to three per department, so that these numbers are not large in proportion to our instructional base. They are essential for our instructional base and they are the things that make our medical education of this country the best in the world.

So, I am very proud to see this. I think it is very important that this not only be maintained, sir, but extended. I was very much distressed to hear of the comments on the floor of the House yesterday. I think these were by poorly informed people and I should like to insert for the record an accurate account of this situation. Mr. ROBERTS. It will be received.

(The material mentioned follows herewith:)

TABLE 1.-Total number of physicians and number in research and/or teaching,

Sources: Data for 1931, 1940, 1949, and 1957, Physicians for a Growing America, Peport of the Surgeon General's Consultant Group on Medical Education, U.S. Department of Health, Education, and Welfare, PHS Publication No. 709, October 1959, appendix table 6, p. 83.

Data for 1960, total physicians, Health Manpower Source Book, U.S. Department of Health, Education, and Welfare, PHS Publication No. 263, sec. 14, table 1, p. 3; number in research, Manpower for Medical Research, Requirements and Resources, 1965-70, U.S. Department of Health, Education, and Welfare, PHS Publication No. 1001, table 16, p. 15, and p. 18.

TABLE 2.—Number of physicians in the United States, and ratio to population of all physicians and of those in research and teaching

Sources: U.S. population, Statistical Abstract of the United States, 1962, p. 5.

Total physicians and physicians in research and teaching, data for 1931, 1940, 1949, 1957, Physicians for a Growing America, Report of the Surgeon General's Consultant Group on Medical Education, U.S. Department of Health, Education, and Welfare, PHS Publication No. 709, October 1959, appendix table 6, p. 83.

Data for 1960, total physicians, Health Manpower Source Book, U.S. Deaprtment of Health, Education, and Welfare, PHS Publication No. 263, sec. 14, table 1, p. 3; number in research, Manpower for Medical Research, Requirements and Resources, 1965-70, U.S. Department of Health, Education, and Welfare, PHS Publication No. 1001, table 16, p. 15, and p. 18.

TABLE 3.-Proportion of medical graduating classes in selected years making specific types of career choices in medicine

1 Data for 1961 revised by AAMC (Dr. Lee Powers) subsequent to the release of the Datagrams, as follows: Specialty practice, 76 percent; research and teaching, 6 percent.

Source: Datagrams, Association of American Medical Colleges, vol. 3, No. 9, March 1962. Data on 1950class collected in 1959 when they were in practice; data on 1958 class collected at time of 1959 AAMC Teaching Institute; data on 1959 class collected at time of graduation; data on 1960 and 1961 classes collected 2 months after graduation, during internship.

TABLE 4.—Percent distribution of medical college classes of 1935, 1940, and 1945 by type of activity in 2 surveys1

1 1st survey for class of 1935 was in 1950, 15 years after graduation. 1st survey for class of 1940 was in 1950, 10 years after graduation, interrupted by World War II. 1st survey for class of 1945 was in 1954, 9 years after graduation. 2d survey was taken in 1959.

Source: Weiskotten, Herman G. (and others), "Changes in Professional Carcers of Physicians," Journal of Medical Education, vol. 36, No. 11, November 1961, pp. 1565 ff.

TABLE 5.-Percent of medical college graduates in teaching and/or research, by year of graduation

1 1st survey for class of 1935 was in 1950, 15 years after graduation.
1st survey for class of 1940 was in 1950, 10 years after graduation, interrupted by World War II.
1st survey for class of 1945 was in 1954, 9 years after graduation.

Source: Weiskotten, Herman G. (and others), "Changes in Professional Careers of Physicians," Journal of Medical Education, vol. 36, No. 11, November 1961, pp. 1565 ff.

TABLE 6.-Career preference of 10-percent sample of 1st-year medical college

1 Multiple responses, total of detail greater than 100 percent.

Source: Total: "Great Aspirations," vol. 1, Rep. No. 90, National Opinion Research Center, March 1963, table 7.28, p. 517. Distribution by Academic Performance Index, special tabulation prepared by NORO for the National Institutes of Health.

[U.S. Department of Health, Education, and Welfare, PHS publication 1001, pp. 21, 22] ABSTRACT FROM "MANPOWER FOR MEDICAL RESEARCH, REQUIREMENTS AND RESOURCES, 1965-1970"

Impact upon the total supply of physicians to meet the health needs of the Nation.-It is estimated that approximately 11,000 additional M.D.'s will enter research, 1961-70. What impact is this likely to have upon the total supply of physicians?

Över the long run, the only adequate answer to this question is to expand the total supply to meet the Nation's total health needs for medical care, teaching, and research. The following observations, however, are pertinent to a serious consideration of the shortrun implications.

1. Assuming that 11,000 new M.D.'s enter research, 1961-70, the proportion of M.D.'s in research and teaching to all physicians probably will rise from 4 percent in 1960 to more than 6 percent by 1970.

2. In 1960, nearly four-fifths of the M.D.'s in research were located in universities and research institutes (see table 10). Virtually all the M.D.'s in research in this sector were either full-time members of the clinical faculties of medical schools or staff in independent teaching and research hospitals. Of the remaining one-fifth, all but 5 percent were employed in Federal and State hospitals and health agencies.

3. Most of the M.D.'s engaged in research in medical schools and in nonGovernment and Government hospitals also teach medical students, instruct interns, and supervise the training of residents and postdoctoral fellows.

4. Most of these M.D.'s also render a wide range of health services in the inpatient and outpatient programs administered through the modern medical centers affiliated with medical schools or operated by Federal and State agencies. 5. In brief, M.D.'s engaged part time in research also perform teaching and service functions. Thus, the entrance into research of an estimated 11,000 M.D.'s 1961-70, does not represent a corresponding diversion from medical care and teaching activities.

Mr. O'BRIEN. Isn't it a fact, Doctor, that their research makes better doctors of the ones who are in the field?

Dr. SHANNON. Absolutely, sir.

Mr. O'BRIEN. Thank you very much.

Mr. ROBERTS. Thank you, Dr. Shannon, for your presentation up to this point and especially for your explanations.

Dr. SHANNON. Mr. Roberts, it is a good break because we start in with some of our problems from here on.

Mr. ROBERTS. Thank you, sir.

I would like to make this announcement for the benefit of the witnesses who are to appear. There is a rule of the House that these statements must be filed 5 days prior to the hearing, and the Chair would like to ask that as much of that rule as is left be complied with. It is very difficult for this committee to review these complex statements. Most of us are laymen, and you speak the language of an art we are not too familiar with. In order that we may do our homework we would like to have these statements as much ahead of time as possible.

The subcommittee will stand in recess until 10 o'clock tomorrow morning.

(Whereupon, at 12:05 p.m., the committee recessed, to reconvene on Thursday, April 25, 1963, at 10 a.m.)

ORGANIZATION OF PUBLIC HEALTH SERVICE

THURSDAY, APRIL 25, 1963

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND SAFETY
OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The subcommittee met at 10 a.m., pursuant to recess, in the caucus room, Cannon Building, Hon. Kenneth Roberts (chairman of the subcommittee) presiding.

Mr. ROBERTS. The subcommittee will please be in order.

I believe, Dr. Shannon, you were over on page 21 of your statement yesterday and, before you resume, I would like to try to give you an idea about the program for today.

As you know, the House goes in session at 11 o'clock, so we will move along until that time and if the subcommittee is able to get unanimous consent to sit this afternoon we will be at the regular committee hearing room of the Public Works Committee. That is tentative, however. It depends on whether or not I am able to get permission for us to resume our hearings. I hope that we can. We have a lot of ground to cover.

Dr. Shannon, you may proceed with your statement.

STATEMENT OF DR. LUTHER L. TERRY, SURGEON GENERAL; ACCOMPANIED BY DR. DAVID PRICE, DEPUTY SURGEON GENERAL; DR. JAMES M. HUNDLEY, ASSISTANT SURGEON GENERAL FOR OPERATIONS; ELTON WOOLPERT, ASSISTANT TO THE SURGEON GENERAL FOR LEGISLATION, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; DR. JAMES A. SHANNON, ASSISTANT SURGEON GENERAL, NATIONAL INSTITUTES OF HEALTH; AND DR. ROBERT ANDERSON, CHIEF, BUREAU OF STATE SERVICES (ENVIRONMENTAL HEALTH); AND JOSEPH S. MURTAUGH, CHIEF, OFFICE OF PROGRAM PLANNING, NATIONAL INSTITUTES OF HEALTH-Resumed

Dr. SHANNON. Mr. Roberts, I would be very glad to.

I should like now to turn my attention to what lies ahead and to some of the problems and issues that confront us in the further development of our programs. I believe the presentation thus far clearly indicates that the research programs of the National Institutes of Health now constitute the Nation's principal instrument for the advancement of the biomedical sciences. As such, they exert a profound influence upon the general direction and character of national development in this area.